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Keys to Success with your CPAP or BiLevel Machine
Webinar and CEC InstructionsSend an email to confirm your attendance to:
Survey invite will be sent tomorrow – new format
Certificates emailed at end of month
PLEASE MUTE!
Why GreenU? Provide more seamless patient care
Maintain educational contact
Promote DME accountability
Build the sleep network through
mysleepworld.com
What is CPAP? Continuous positive airway pressure or CPAP
therapy is a prescribed treatment delivered to
the upper airway to keep it open during the
night.
The pressure is delivered through tubing
attached to a mask and held in place by a
headgear
Bi-Level Bi-level therapy is similar to CPAP but it uses two
pressures
Inspiratory pressure
Expiratory pressure
With Bi-Level therapy, inspiratory pressure is higher than the expiratory, making it easier to
exhale because the pressure is decreased
• Why is Bi-Level Therapy used?
Therapeutic or Treatment? Humidification
Active humidification monitoring
Heated Circuits
Electronic pressure relief
Use & Compliance Data
Event detection monitoring
Compliance
Wireless
Issues With Their Mask
What is the number one cause
of people failing PAP Therapy?
• Masks must fit properly
• People stop using PAP when they have mask related problems
• Early (first week) problem solving improves PAP compliance
• Variety of masks on the market
• 30 day mask guarantee
• New masks available
• Shop before you buy
• Replace early or every three months
Mask Fit: Keys to Success
Common mask related problems
Pressure points where mask meets skin
Blisters Most common on the bridge of the nose
Blisters may break open and become infected
Leaks – air blowing around ‘seal’ of mask
Most machines will compensate for a small leak
Eye leaks
Beards/moustaches
Worn Mask
Dryness
Signs of a worn mask Ask patient to bring with them to lab
Increased leaks
Tears or rips
Change in texture of the mask
Gel masks
become soft
lose shape
Silicone masks
Develop ‘dry rot’ and crack
Stretching
Replacing Supplies General rule of thumb (most insurance
providers)
Replace filters monthly
Replace mask every three months
Replace headgear every six months
Replace tubing two to three times per year
* Contact your home care company for details on your coverage
Prevention of Pressure Sores Do not over tighten your mask
Have your mask as loose as possible without having a leak
Wash your mask daily with warm, soapy water
If you do get pressure sores: Don’t Wait!
Contact your home medical equipment provider, you may need a different mask
You cannot keep using the same mask as it will cause the sore to open
Neosporin, Moleskin or other OTC remedies
Care and Cleaning Tubing should be cleaned weekly
Submerse tube in warm solution, rinse well, hang to dry
Headgear should be cleaned weekly Wash in warm solution, rinse well, hang to dry
Clean more regularly in warm weather or when
you have a cold or respiratory infection
Adjust the straps and headgear on your mask to obtain a better fit.
If you have had your mask for a while, check to
make sure that it is not worn or torn.
You may need to try a different size mask.
A different type of mask may work better for
you. Either a full face mask or nasal pillows may eliminate the air leaks.
Talk to your PAP supplier if you continue to have
problems with air leaks.
Care and Cleaning (continued)
Distilled + Distilled = Success Distilled water in humidification chamber
More likely to be sterile
No dissolved solids
Fluoride, calcium, phosphorus
Distilled white vinegar for cleaning
50/50 Solution
Inexpensive and safe
No perfumes or moisturizers
Inexpensive and replenishable
Five Common Problems
Problem #1: User seems to have more
nasal congestion after using PAP. This is the most common side effect of PAP therapy. User may
also have a runny, dry nose or nosebleeds. Nasal congestion often goes away after your first month of use.
Suggest that the patient talks to their doctor if their congestion
is severe or if they are experiencing nasal, sinus or ear pain.
These tips can also help reduce nasal problems:
• Try using a saline nasal spray. Apply a few sprays in
each nostril before using PAP therapy.
• Try a nasal decongestant. Some types require that
the patient has a prescription from their doctor.
• Try using/adjusting Heated Humidifier.
Problem #2: The patient is having trouble
breathing with so much air coming in
through the mask. This problem is common if the OSA is severe and the
patient need a high level of air pressure to keep the
airway open, there is also an acclimation period for
most users.
Try these tips: Begin using PAP for short periods of time during the day
TV
Reading
This can help the body begin to adjust to the air pressure
One may need to start by using it for only a few minutes at a time
Gradually increase the length of the sessions. Focus on breathing at a
nice, slow pace
Use the unit's ‘ramp’ setting
Problem #3: The patient is experiencing a
dry or sore throat after using PAP.
Anyone who breathes through his or her mouth during sleep may have this problem.
These tips may help relieve throat irritation
caused by PAP: Try a chin-strap, available through a home-care company.
Heated humidity is a feature on many machines that
requires adjustment. If available, turn the humidity up one
night at a time.
In some cases, a full face or different style of mask will help.
Problem #4: The patient has red eyes, continues snoring or stops breathing
during sleep.• These problems are all signs that air may be
leaking out of the mask.
• These tips can help correct the problem:• Loosen the straps slightly so that they are not too tight.
Make sure the mask is still snug enough to prevent air leaks, but not so tight that it hurts the facial skin.
• Consider buying pads that slip over the straps. Made of
fleece or other soft material, they keep the straps from
rubbing against the skin.
• Talk to the CPAP supplier if the mask continues to irritate skin or cause soreness.
Problem #5: Air delivered through the mask is cold and disrupts sleep.
The environmental elements may affect the use of PAP
therapy. Room temperature, humidity and bed location
can all affect the air flowing from the machine through
the mask. The following suggestions may help:
Try heating the room
Placing the tubing under the bedclothes
Obtaining a Snuggle Hose
Heated humidification
Frequently Asked Questions
How long will it take to get used to CPAP?
Most people adjust to CPAP in one to two weeks
but it may take up to a month or more to adjust.
Many factors affect adjustment period:
Severity of Apnea
Pressure
Mask
Humidity
Bed Partner
Patient Education
How soon after the patient begins using
treatment that they may notice
improvement? Many patients notice an immediate improvement, some
people may take a little longer to recognize
improvement.
Several health conditions are affected by sleep apnea
including:
Hypertenstion
Cardiovascular Disease
Type II Diabeties
Depression
More
How often will the patient need to use their treatment?
The patient will need to attempt to use their equipment each time they sleep. If they do
not, they will return to the previous level of snoring, sleep apnea, and daytime tiredness.
Will the pressure on the device ever need
changing?
• It may. There are a few things that affect the need for a
pressure change, and it’s important to keep in
communication with the ordering physician about the
treatment of apnea. Some items that may affect the
amount of pressure required are:
Weight loss/gain
Snoring returns
Daytime sleepiness returns
Changes in your overall health
Will the patients’ blood pressure improve after
starting treatment?
One of the positive effects of PAP compliance is the
possibility of lowering blood pressure. The patient needs
to discuss this further with their physician before making
any medication changes.
The ordering doctor should review blood pressure
regularly even if the patients mediation does not change initially.
Is it easier to lose weight when using PAP therapy?
It may be. One should find that his or her energy levels
will increase. It is also likely to notice more motivation to
take part in many activities that previous sleepiness has
prevented.
Permanent weight loss requires long-term lifestyle changes to diet and exercise.
The patients nose gets blocked
regularly, so he or she has to breathe through their mouth.
The nose is often the point of entry when using PAP
therapy.
Nasal Decongestant
Please note that overuse of nasal decongestants can also
cause a blocked nose over time and are really only a
temporary solution.
Full Face Mask
A full face mask covers both the nose and mouth so that
the patient can continue to receive effective therapy, even if they are breathing through their mouth.
The patient feels air leaking out of his or her mouth as they fall asleep.
The mouth needs to be closed while sleeping to
prevent any air escaping from the mask.
A full face mask that covers the nose and mouth
will ensure that the patient will continue to
receive effective therapy as he or she falls asleep.
A chin strap, obtained through a medical
supplier, can help to keep the patients mouth closed.
Can the patient use PAP treatment if he or she has a cold?
If the patient is experiencing an infection of the upper
respiratory tract, middle ear, or sinus, he or she should
consult your physician before continuing treatment.
One may be advised to discontinue until the infection has
cleared.
If the patient continues with treatment during infection, it is
advisable to wash the mask and tubing more often.
A full face mask may be good alternative at this time, as it
covers both the nose and mouth so the patient can continue to receive effective therapy.
Should the patient take his or her device to
the hospital with them, if hospitalization is ever
needed for any reason?
Yes.
If the patient is having surgery, it is very
important that they tell both the surgeon and
the anesthetist that they wear a PAP device. Do this before the date of the surgery, if possible.
One should also inform the physician treating
the patient for sleep apnea that he or she is going to be in the hospital.
Will the patient ever be able to stop
treatment? Will he or she ever be cured of
snoring and sleep apnea?
OSA is a long-term condition for which there is
presently no known cure.
The good news, however, is that PAP therapy
will effectively control sleep apnea-as long as
the patient continues to use it.
Technology continues to improve, making PAP more effective and comfortable.
The patient often takes the mask off in their
sleep. How can the patient avoid this?
It may indicate that the treatment pressure is not enough to completely control sleep apnea and
a slight increase in pressure may solve the
problem.
Speak with the ordering physician about this issue. Often it can be corrected quite easily –
but it is important that the doctor is aware of this
problem.
Mask alarms available on some PAP machines
Why is the patient having difficulty breathing
out during CPAP?
When first using CPAP, most people find they
experience a need to push against the airflow when they breathe out. It may take a little time
to get used to breathing out against the
pressure.
Practicing sessions in the daytime while relaxing or listening to music may help overcome this
feeling. However, breathing out against the flow
of air will happen automatically when the
patient is asleep.
Don’t forget about Ramp.
Can the patient use their machine in other
countries?
Most devices have a switch mode power supply.
Please note that the patient will still need to use
the correct adaptor for the type of power outlet
in the country he or she is visiting.
Contact the patients home care company or
Sleep Solutions Home Medical Equipment for equipment options before the trip.
Questions